Nalidixic acid in children: retrospective matched controlled study for cartilage toxicity

The new fluoroquinolones allow effective oral therapy of infections due to Pseudomonas aeruginosa. Studies on efficacy and safety of these promising agents are not recommended in childhood because of cartilage toxicity which has been observed in growing animals. However, the first quinolone antimicrobial, nalidixic acid, showed identical arthropathic effects in young animals and is licensed for paediatric use. A review of the hospital charts revealed 11 patients who had received nalidixic acid over nine to 600 days and were available for control examination three to 12 years later. For each nalidixic acid case a carefully selected matched pair, who had never received nalidixic acid, was identically analyzed. Three patients from the nalidixic acid and three from the control group reported arthralgia, which was judged to have no relation to drug therapy. Growth curve and both functional and radiological joint findings were completely normal in all cases. These results suggest that quinolone-associated arthropathy does not occur in children, even after long-term therapy.